Multiple beam laser treatment device

ABSTRACT

Embodiments of the invention include a treatment device and corresponding treatment method for laser wound healing, the device and method making use of the simultaneous action of multiple laser types and laser wavelengths which are applied at human tissue. The treatment device generally includes a laser system and a hand-piece which is coupled to the laser system. The hand-piece is designed so that one or multiple laser beams are applied at relatively small spot and at a relatively high power level, and are surrounded by a relatively large spot of another laser beam with a relatively low power level. In a preferred implementation, the hand-piece is adapted to facilitate the emission of first and second laser beams together with a third laser beam which is delivered at a different spatial profile in comparison to the first and second laser beams.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation application of U.S. application Ser.No. 14/610,650, entitled “MULTIPLE BEAM LASER TREATMENT DEVICE”, filedJan. 30, 2015, which claims the benefit of and priority to U.S.Provisional Application No. 61/934,599, entitled “MULTIPLE BEAM LASERTREATMENT DEVICE” filed Jan. 31, 2014, the entire contents of which areincorporated herein by reference.

BACKGROUND OF THE INVENTION Field of the Invention

Embodiments of the invention relate generally to medical laser systemsand, more particularly, to devices and methods for multiple beam lasertreatment in which tissue sites are simultaneously exposed to differentlaser types and laser wavelengths for improved therapeutic effect.

2. Description of Art

Lasers find application in a variety of medical and dental treatmentprocedures, with some of the most common operations involving thecutting, ablation, disinfection or other treatment of tissue. Dependingon the particular wavelength, output power, pulse width of the laseremission, and the absorptivity of the target tissue, varying biologicalmaterials from soft tissue such as muscles and skin, to hard tissue suchas teeth and bones, can be cut and ablated. Laser systems with outputpower levels up to the tens of watts can be used for these applications,although lower powered laser systems with output power levels in the 10milliwatt range can be used in microbicidal applications, tissuebiostimulation applications, low-level light therapy, and othernon-tissue-destructive applications.

A conventional laser system generally includes three primary components:a laser medium that generates the laser light, a power supply thatdelivers energy to the laser medium in the form needed to excite thesame to emit coherent light, and an optical cavity or resonator thatconcentrates the light to stimulate the emission of laser radiation.Laser emissions can range from ultraviolet wavelengths, visible lightwavelengths, to infrared wavelengths, depending on the type of lasermedium utilized, whether the medium comprises one or more gases,chemicals, dyes, metal vapors, and whether the laser is solid state, orsemiconductor, etc.

In high output power surgical laser applications, solid state typelasers are often used in which the laser medium is comprised of a solidhost crystalline or glass structure that includes at least one dopantmaterial. Particular dopant materials and the corresponding emissionwavelengths are well known in the art. For example, in hard and softtissue ablation applications, neodymium-doped yttrium aluminum garnet(Nd:YAG) lasers with an emission wavelength of about 1.064 μm,erbium-doped yttrium aluminum garnet (Er:YAG) lasers with an emissionwavelength of 2.94 μm, and holmium-doped yttrium aluminum garnet(Ho:YAG) lasers are frequently utilized. Furthermore, erbium chromiumdoped yttrium, scandium, gallium garnet (Er, Cr:YSGG) lasers have beenutilized successfully in medical treatment applications. Other lasermedia utilizing gasses such as carbon dioxide, argon, copper vaporlasers, and excimer media (e.g., using noble gas halides) have also beenused with success.

During operation of a typical laser system, the laser medium (e.g., thedoped solid host structure) is excited to a population inversion statewith an optical pump such as a flash lamp that generates short-duration,intense, incoherent, full spectrum light. In the population inversionstate, atoms of an elevated energy state exceed those of a lower energystate.

Instead of flash lamps, electrically powered diode lasers can also beutilized. The laser medium is disposed between two or more reflectivemirrors that define an optical resonator. With each reflection off ofthe mirrors, the light is further stimulated by the optical pump,leading to its amplification. One of the mirrors is a partial reflectorwhich allows some of the amplified light to exit the cavity as the laseremission, and can also be referred to as an output coupler. The laseroutput is typically pulsed by such techniques as Q-switching, which canresult in substantially higher instantaneous laser power output, andcontinuous or quasi-continuous operation is also possible.

A laser diode can also be utilized in medical treatment applications.Similar in operation to light emitting diodes, the laser diode iscomprised of a p layer and an n layer with an active photon emittinglayer in between the p and n layers. Similar to the solid state laser,there are one or more reflectors as well as an output coupler, all ofwhich are incorporated into the semiconductor assembly, with electricalcurrent providing the stimulus to reach the population inversion state.

A conventional laser apparatus suitable for surgical applications isgenerally comprised of the aforementioned laser energy source and aseparate handpiece coupled thereto that can be manually operated by thepractitioner. In a basic implementation, the handpiece includes a tipthat is in optical communication with the waveguide and the laser energysource. The tip directs the emitted laser onto a target tissue site, andvarying shape configurations can yield different output profiles,including simple circular patterns. The laser emission can be directedat any angle that maximizes operator flexibility and comfort inaccessing the target tissue site. The optical pathway can be offset fromthe connecting cable and handpiece axis using different reflectorarrangements.

As briefly mentioned above, cutting and ablative efficacy largelydepends upon the emitted wavelength and the absorptivity of thatparticular wavelength by the target tissue. Further, the intensity ofthe emission, along with the duration of the pulse, must be set toensure that the tissue does not boil or vaporize, which can lead togreater injury and hemorrhaging. Following irradiation with 4 laseremission, the ablated tissue region is surrounded by a carbonizationzone, a zone loosened by vacuoles, a coagulation zone, and a reversiblythermally damaged zone. The formation of the coagulation zone and theresultant hemostasis is advantageous in that tissue can be cut withoutbleeding.

In order to achieve the best results with the least amount of damage tothe surrounding tissue, the laser emission parameters must be optimizedfor each clinical application. Most laser treatment devices aretherefore dedicated to one operation, although supplemental featuresthat do not involve laser emissions are also known. For example, a watersupply line and an air supply line can be incorporated into thehandpiece to deliver water and air to the target tissue area. This coolsthe target tissue and helps to remove debris. To further aid in theremoval of debris, vacuum lines can be incorporated. The use of waterand air to improve efficacy has not been limited to these objectives,and an alternative cutting mechanism by which laser energy is directedto a distribution of atomized fluid particles located in a volume ofspace away from the targeted tissue site has been developed anddisclosed in, for example, Applicant's U.S. Pat. No. 5,741,247 toRizoui, the disclosure of which is incorporated herein by reference. Thelaser energy is understood to interact with the atomized fluid particlescausing the same to expand and impart mechanical cutting forces onto thetarget surface.

To the extent multiple laser emissions can be incorporated into a singlelaser system, existing laser systems such as those disclosed in U.S.Pat. No. 5,139,494 to Freiberg involve the use of a single lasercatheter to the target tissue that is engaged to multiple sources oflaser energy, each of which has a different therapeutic effect. Thelaser sources can be separately activated, and while concurrentoperation is indicated, each of the laser energy sources is configuredto operate as an independent unit to known effect. Alternatively, someothers have contemplated the adjustment of the laser source to enablethe selective emission of laser energy at different wavelengths anddurations.

Accordingly, there is a need in the art for improved laser treatmentsutilizing concurrent laser emissions in order to achieve enhancedtreatment capabilities that exceed those of such multiple laseremissions operated independently. There is also a need in the art forsuch laser treatments to achieve improved wound debridement, bacteriareduction and/or inactivation, biostimulation, tissue ablation,coagulation, and biofilm disruption, as well as combinations thereof ina single procedure.

SUMMARY OF THE INVENTION

In accordance with embodiments of the invention, there is provided atreatment device and corresponding treatment method for laser woundhealing. The device and method make use of the simultaneous action ofmultiple laser types and laser wavelengths which are applied to humantissue. The treatment device generally comprises a laser system and ahandpiece which is connected to the laser system. The handpiece isdesigned so that one or multiple laser beams are applied at a relativelysmall spot and at a relatively high power level, and are surrounded by arelatively large spot of another laser beam with a relatively low powerlevel. In at least one embodiment, the handpiece is adapted tofacilitate the emission of a first and a second laser beam together witha third laser beam. The third laser beam is delivered at a differentspatial profile in comparison to the first and second laser beams.

In some embodiments, the handpiece can be provided in any one of amultiplicity of different configurations. In one embodiment, thehandpiece generally comprises a relatively long central waveguide whichis adapted to facilitate the delivery or emission of the first andsecond laser beams while working in contact with a surface such assubject tissue, or in very close proximity to the surface thereof. Insome embodiments, the third laser beam can be delivered to the tissuethrough a different waveguide, and can effectively surround theapplication area of the central waveguide. In this regard, in someembodiments, the first and second laser beams can be applied in asmaller central spot, while being surrounded by the third laser beam. Byway of example, and not by way of limitation, a handpiece constructionwhich is suitable to facilitate the generation of at least the first andsecond laser beams along the common central waveguide is described withparticularity in Applicant's co-pending U.S. patent application Ser. No.14/587,955 entitled Dual Wavelength Laser Treatment Device filed Dec.31, 2013, the disclosure of which is incorporated herein by reference.Other potentially suitable handpiece constructions are found inApplicant's U.S. Pat. No. 7,292,759 to Boutoussov et al; U.S. Pat. No.7,461,982 to Boutoussov et al; U.S. Pat. No. 7,578,622 to Boutoussov;and U.S. Pat. No. 7,563,226 to Boutoussov, the disclosures of which arealso incorporated herein by reference.

In some further embodiments of the invention, the handpiece can comprisevarious non-contact optical components (e.g., one or more lenses andwindows). In some embodiments, the non-contact optical components cancollectively function in a manner where the laser beam pattern, afterpropagation through a free space, forms essentially the same profile onthe tissue surface as described above, i.e., the first and second laserbeams are applied in smaller central spot, while being surrounded by thethird laser beam.

In some embodiments, the first, second and third laser sources can beoperated in concert to generate combined laser emissions thatsynergistically enhance tissue treatment. Furthermore, in someembodiments, the efficacy of treatment with all three laser emissionscan potentially be increased with the addition of a water spray that,for ablative forms of treatment, can reduce ablation width, increaseablation depth, and reduce charring that can harm the surroundingtissue. Further, in some embodiments, the use of three laser sourcessynergistically can provide bactericidal, bio-stimulation or woundhealing, and pain reduction benefits. In this regard, althoughembodiments of the invention described herein can be utilized inrelation to wound treatment and healing (e.g., surface debridement,bacteria reduction and bio-stimulation) other clinical applications,like tissue cutting and bacteria reduction can also be effectivelyimplemented. Moreover, in some embodiments, a control system thatselectively governs the emissions from the first, second and third lasersources can accomplish the aforementioned functions.

Embodiments of the invention can be best understood by reference to thefollowing detailed description when read in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

These, as well as other features of the invention, will become moreapparent upon reference to the drawings wherein:

FIG. 1 is a front view showing an emission end of a laser treatmentdevice in accordance with a first embodiment of the invention;

FIG. 2 is a side profile view of the emission end of the laser treatmentdevice shown in FIG. 1, further illustrating an embodiment of a laseremission pattern therefrom;

FIG. 3 depicts an example laser emission pattern on a target tissue siteas output from the first embodiment of the laser treatment device shownin FIGS. 1 and 2;

FIG. 4 is a front view showing an emission end of the laser treatmentdevice in accordance with a second embodiment of the invention;

FIG. 5 is a side profile view of the mission end of the laser treatmentdevice shown in FIG. 4, further illustrating an embodiments of a laseremission pattern therefrom; and

FIG. 6 depicts another embodiment of a laser emission pattern on atarget tissue site as output from the second embodiment of the lasertreatment device shown in FIGS. 4 and 5.

Common reference numerals are used throughout the drawings and detaileddescription to indicate like elements.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to the drawings illustrating some embodiments of theinvention, and not for purposes of limiting the same, FIG. 1 depicts theemission end 10 of treatment device comprising a handpiece 12 integratedinto a multi-wavelength laser treatment device constructed in accordancewith a first embodiment of the invention. Though not shown in FIG. 1, insome embodiments, the treatment device will further include a laser beamgenerating system which is operatively coupled to various laser beamtransmission modalities integrated into the handpiece 12, as will bedescribed in more detail below.

As shown in FIG. 1, in some embodiments, the handpiece 12 can comprise amain body 11 where a portion of the handpiece 12 defining the emissionend 10 can comprise a generally cylindrical configuration defining anaxis A. Therefore, in some embodiments, the emission end 10 can comprisea generally circular profile. However, those of ordinary skill in theart will recognize that this particular shape only illustrates someembodiments, and the shapes can be modified in the treatment device ofthe first embodiment without departing from the spirit and scope of theinvention.

Referring to FIG. 2, in some embodiments, protruding from theapproximate center of the emission end 10 of the handpiece 12 andextending along the axis A is the distal end portion 14 a of anelongate, central waveguide 14 of the treatment device (comprisinghandpiece 12), at least a portion of which is integrated into thehandpiece 12. In some embodiments, the central waveguide 14 has agenerally circular cross-sectional configuration, and defines a distalemission or output end 16. Thus, in some embodiments, at least thatportion of the axis of the central waveguide 14 defined by the distalend portion 14 a thereof protruding from the emission end 10 iscoincident with the axis A. Though not shown, in some embodiments, inaccordance with a variant of the treatment device of the firstembodiment, the output end 16 of the central waveguide 14 can besubstantially flush or substantially continuous with the emission end10, rather than protruding therefrom. Further, in some otherembodiments, the central waveguide 14 can comprise a diameter that islarger or smaller than illustrated. Thus, the output end 16 of thecentral waveguide 14 can also comprise an area that is relatively largeror smaller than illustrated in some embodiments.

In some embodiments of the invention, the treatment device of the firstembodiment comprising the handpiece 12 can comprise a central waveguide14 that can be adapted to facilitate the delivery or emission of atleast one laser beam. For example, in some embodiments of the invention,the treatment device of the first embodiment comprising the handpiece 12can comprise a central waveguide 14 that can be adapted to facilitatethe delivery of two laser beams from an output emission surface 16 a ofthe output end 16. For example, in FIG. 2, the first laser beam asemitted from an output emission surface 16 a of the output end 16 of thecentral waveguide 14 is identified by the arrow labeled A1, with thesecond laser beam as emitted from the output emission surface 16 a ofthe output end 16 of the central waveguide 14 is identified by the arrowlabeled A2. In some embodiments, the first laser beam A1 and the secondlaser beam 42 can be substantially coincident and coaxial. In some otherembodiments, the first laser beam A1 and the second laser beam A2 can beat least partially coincident and coaxial. In some other embodiments,the first laser beam A1 and the second laser beam A2 can besubstantially parallel. In some other embodiments, the first laser beamA1 and the second laser beam A2 can be divergent.

In some embodiments of the invention, the treatment device can comprisea handpiece 12 that can further comprise a plurality of peripheral lightpipes or waveguides. For example, in some embodiments of the invention,a plurality of peripheral light pipes or waveguides 18 can be at leastpartially integrated into the handpiece 12. Referring to FIG. 1, in someembodiments, the handpiece 12 can comprise eight peripheral waveguides18 positioned within the main body 11. Those of ordinary skill in theart will recognize that this number can be increased or decreasedwithout departing from the spirit and scope of the invention, and otherembodiments can include more or fewer peripheral waveguides 18 thanshown. In some embodiments, one or more peripheral waveguides 18 can bepositioned in the main body 11 between the outer edge 17 of the centralwaveguide and the outer surface 13 of the main body 11. In someembodiments, the peripheral waveguides 18 can be positioned to at leastpartially encircle the central waveguide 14 (i.e., the central waveguide14 is concentrically positioned with the peripheral waveguides 18). Insome embodiments, the peripheral waveguides 18 are substantially equallyspaced (as depicted in FIG. 1). In other embodiments, at least someperipheral waveguides 18 are unequally spaced.

In some embodiments of the invention, at least one of the peripheralwaveguides 18 can comprise a generally circular cross-sectionalconfiguration. Further, in some embodiments, at least one of theperipheral waveguides 18 can comprise a generally circularcross-sectional configuration that defines a distal emission or outputend 20. For example, as illustrated in FIG. 1, in some embodiments, thehandpiece 12 can comprise a main body 11 including eight peripheralwaveguides 18 that can comprise a generally circular cross-sectionalconfiguration defining a distal emission or output end 20. Moreover, insome embodiments, at least one of the peripheral waveguides 18 can bepositioned in the main body 11 to be substantially flush orsubstantially continuous with the emission end 10 rather than protrudingtherefrom.

In some embodiments of the invention, the treatment device of the firstembodiment comprising the handpiece 12 includes peripheral waveguides 18that are adapted to emit a third laser beam from an output emissionsurface 21 of output ends 20 thereof. For example, referring to FIG. 2,some embodiments include a third laser beam (identified by the arrowslabeled A3) that is emitted from the output ends 20 of the peripheralwaveguides 18 through at least one output emission surface 21. Thedepiction represents the example embodiment of the collective emissionfrom the plurality of peripheral waveguides 18 (i.e., the total emissionof the third laser beam A3 is derived from output from the eightperipheral waveguides 18). In some other embodiments, the third laserbeam A3 can comprise emission of laser radiation from less than theeight peripheral waveguides 18 depicted in FIG. 1. For example in someembodiments, the third laser beam A3 can comprise laser radiation frombetween one and seven peripheral waveguides 18. Moreover, in some otherembodiments, additional peripheral waveguides 18 can be included to emitlaser radiation that can fin m part of the third laser beam A3.

Though not shown, in some embodiments, the laser beam generating systemincluded in the treatment device of the first embodiment can include atleast three separate, conventional laser sources. In some embodiments,the first and second laser sources can be operatively coupled to aninput end of the central waveguide 14, with the third laser source beingoperatively coupled to input ends of the peripheral waveguides 18. Insome embodiments of the invention, the first laser source can comprise adiode laser. Further, in some embodiments, the operational parameters ofthe first laser source can comprise a wavelength of about 940 nm in acontinuous wave (CW) mode and at an average output power in a range offrom about 1 W to about 10 W. In some further embodiments, the secondlaser source can be a solid state Er, Cr:YSGG laser, where theoperational parameters can be at a wavelength of about 2.78 μm in ashort pulse mode (H mode) in a range of from about 5 Hz to about 20 Hz,and at an average output power in a range of from about 2 W to about 10W. In some further embodiments, the third laser source can be a diodelaser or LED, where the operational parameters can be a wavelength ofabout 630 nm, or about 810 nm, or about 940 nm in a continuous wave (CW)mode, and at an average output power in a range of from about 50 mW toabout 1000 mW.

Referring now to FIG. 3, in some embodiments, with at least partialintegration of the central and peripheral waveguides 14, 18 therein, thehandpiece 12 of the treatment device of the first embodiment can beconfigured so that the first and second laser beams A1, A2 can beapplied as a spot or emission pattern comprising a first diameter D1comprising a first power level, and surrounded by the third laser beamA3 spot or emission pattern comprising a second diameter D2 comprising asecond power level. In some embodiments, the handpiece 12 can be adaptedto facilitate the emission of the first and second laser beams together,with the third laser beam being delivered at a different spatial profilein comparison to the first and second laser beams. As depicted in FIG.3, in some embodiments, the central area or region of the emissionpattern labeled as R1 can be created by the combined emissions of thefirst and second laser beams (A1, A2) from the central waveguide 14. Insome embodiments, this central region R1 can be at least partiallyencircled by a peripheral area or region of the emission pattern labeledas R2 which is created by the emission of the third laser beam from theperipheral waveguides 18.

In some embodiments, due to the protrusion of the central waveguide 14from the emission end 10 of the handpiece 12, during operation, theoutput end 16 of the central waveguide 14 can be configured to be incontact with the tissue to be treated or disposed in very closeproximity thereto. Thus, in some embodiments, there is a limitedmeasure, if any, of propagation of the combined first and second laserbeams A1, A2 emitted from the output end 16 of the central waveguide 14through free space prior to the same defining the central region R1 ofthe emission pattern on the tissue. In contrast, in some embodiments, inview of the output ends 20 of the peripheral waveguides 18 each beingsubstantially flush with the emission end 10 of the handpiece 12, agreater measure of propagation of the third laser beam A3 collectivelyemitted from the output ends 20 of the peripheral waveguides 18 throughfree space can occur prior to the third laser beam A3 defining theperipheral region R2 of the emission pattern on the tissue.

Some embodiments of the invention include a treatment device of thefirst embodiment where the first laser beam A1 having a first beamcharacteristic can be emitted as a result of the activation of the firstlaser source. Similarly, in some embodiments, the second laser beam A2can be emitted as a result of the activation of the second laser sourcethat can have a second beam characteristic, with the third laser beamemitted as a result of the activation of the third laser source having athird beam characteristic. As utilized herein, the term “beamcharacteristic” refers to any one or combination of emission andoperational parameters, including wavelength, divergence, beam diameter,output power, pulse duration (whether periodic or continuous) and dutycycle, pulse frequency, and any other parameters that can be adjusted toachieve different therapeutic effects. In this regard, in someembodiments, the beam characteristics of the laser beams generated bythe first, second and third laser sources within the treatment devicecan differ from each other, meaning that a least one of the emission andoperational parameters specified above can vary within such laser beams.

Some embodiments of the invention include a configuration of thetreatment device of the first embodiment, including but not limited tothe handpiece 12 thereof, that can enable a combination of the twoseparate emissions of the first laser source and the second laser sourcefor output from the common central waveguide 14. It will be recognizedby those having ordinary skill in the art that beam divergence isgenerally the inverse of the wavelength. As indicated above, the firstlaser source and the second laser source will typically not be operatedat exactly the same wavelength. Accordingly, based on the differingoutput wavelengths alone, beam divergence is likewise understood todiffer between the first laser source and the second laser source. Insome embodiments, beam divergence can also depend on the particulars ofthe laser energy source, and further variability can be introducedbecause of the differing laser types (e.g., the first laser source A1can comprise a diode configuration, while the second laser source cancomprise a solid state configuration). As indicated above, in someembodiments, the handpiece 12 can be configured to emit the first andsecond laser beams A1, A2 with dissimilar beam characteristicscharacterized by different wavelengths and divergences that can becombined into the final transmission path defined by the centralwaveguide 14.

In some further embodiments (not shown), the handpiece 12 of thetreatment device of the first embodiment can further be optionallyoutfitted with a delivery system (e.g., a water supply line and/or anair supply line) to facilitate the delivery of water and air to a targettissue area concurrently with the delivery of laser energy. A morecomprehensive treatment of applicant's existing technology describingthe structural and functional features of such delivery systems in thecontext of laser hand-pieces can be found in U.S. Pat. No. 5,741,247 toRizoiu et al., U.S. Pat. No. 7,702,196 to Boutoussov, et al., and U.S.Pat. No. 8,485,818 to Boutoussov, et al., the disclosures of which areincorporated herein by reference.

Some embodiments of the invention include a treatment device that cancomprise a handpiece 112 configured to emit at least one laser beam. Forexample, referring to FIG. 4, some embodiments of the invention includea handpiece 112 comprising an emission end 110 of the second embodimentof a multi-wavelength laser treatment device. Though not shown in FIG.4, as in the laser treatment device of the first embodiment comprisingthe handpiece 12, the second embodiment of the treatment deviceincluding the handpiece 112 can include a laser beam generating systemwhich is operatively coupled to the handpiece 112 portion of thetreatment device. In some embodiments, a portion of the handpiece 112defining the emission end 110 can include a generally cylindricalconfiguration defining an axis A′, the emission end 110 thus having agenerally circular profile. However, those of ordinary skill in the artwill recognize that this particular shape illustrates some illustrativeembodiments and can be modified without departing from the spirit andscope of the invention.

Referring to FIGS. 4 and 5, in the treatment device of the secondembodiment, the handpiece 112 can comprise various non-contact opticalcomponents (e.g., one or more lenses and windows) which can function ina manner so that after propagation through free space, the laser beampattern emitted from the handpiece 112 can form essentially the sameprofile on the tissue surface as described above and shown in FIG. 3(i.e., where the first and second laser beams A1, A2 can be applied atto a spot or emission pattern comprising a first diameter D1 comprisinga first power level, and surrounded by the third laser beam A3 spot oremission pattern comprising a second diameter D2 comprising a secondpower level). More particularly, FIGS. 4 and 5 each depict an opticalwindow 122 that can be integrated into the main body 111 of thehandpiece 112 so as to define at least a portion of the emission end 110thereof. In this regard, in some embodiments, the optical window 122 cancomprise an outer surface 127 and a generally circular configurationforming a distal emission or output end 126, and can define an axiswhich is coincident with the axis A′.

Further, in some embodiments, the outer diameter of the optical window122 can be smaller than the outer diameter of the main body 111 of thehandpiece 112 defining the emission end 110. Moreover, in someembodiments, the optical window 122 can be positioned recessed into themain body 111. For example, in some embodiments, the main body 111 cancomprise a recess 111 a into which the optical window 122 can bepositioned. In some embodiments of the invention, the emission end 110can include the output end 126 of the optical window 122 that definesthe outer emission surface 124. Further, in some embodiments, theoptical window 122 can be positioned in the main body 111 (within therecess 111 a) so that the outer emission surface 124 can besubstantially flush or substantially continuous with an outer surface110 a portion of the emission end 110 defined by the remainder of thehandpiece 112.

In some embodiments of the invention, the optical window 122 can beadapted to facilitate the delivery or emission of at least one laserbeam. For example, in some embodiments, the optical window 122 can beadapted to facilitate the delivery or emission of at least a first,second and third laser beams from the outer emission surface 124thereof. Referring to FIG. 5, the first laser beam can be emitted fromthe outer emission surface 124 of the optical window 122 and isidentified by the arrow labeled A1′. Further, the second laser beam canbe emitted from the outer emission surface 124 of the optical window 122identified by the arrow labeled A2′. Further, the third laser beamemitted from the outer emission surface 124 of the optical window 122 isidentified by the arrows labeled A3′.

In some embodiments, the treatment device of the second embodiment(comprising handpiece 112) can comprise can include three laser sources.In some embodiments, the functional attributes of these first, secondand third laser sources can be substantially the same as those describedabove in relation to the first, second and third laser sources,respectively, of treatment device constructed in accordance with thefirst embodiment of the invention (comprising handpiece 12). In someembodiments, the treatment device of the second embodiment, and inparticular the handpiece 112 thereof, can be configured to facilitatethe operative coupling of the first, second and third laser sources tothe optical window 122.

Referring now to FIG. 6, some embodiments of the treatment device of thesecond embodiment, including the handpiece 112 thereof, can beconfigured so that the first and second laser beams can be applied at afirst spot and at a specific first power level, and are surrounded by asecond spot of the third laser beam with a second power level. In someembodiments, the handpiece 112 can be adapted to facilitate the emissionof the first and second laser beams together (forming the first spot),with the third laser beam being delivered at a different spatial profilein comparison to the first and second laser beams. In FIG. 6, thecentral area or region of the emission pattern labeled as R1′ can becreated by the combined emissions of the first and second laser beamsfrom the optical window 122 (i.e. forming the first spot). This centralregion R1 is circumvented by a peripheral area or region of the emissionpattern labeled as R2 which is created by the emission of the thirdlaser beam from the optical window 122 (i.e., the second spot).

In some embodiments, due to the outer emission surface 124 of theoptical window 122 being flush with the remainder of the emission end110 in the treatment device of the second embodiment, in normal deviceoperation, there can be a prescribed measure of propagation of thecombined first and second laser beams and the third laser beam emittedfrom the outer emission surface 124 of the optical window 122 throughfree space prior to the same defining the central and peripheral regionsregion R1′ and R2′, respectively, of the laser emission pattern on thetissue.

In some embodiments, in the treatment device of the second embodiment(comprising handpiece 112), the first, second and third laser beamsemitted as a result of the activation of respective first, second andthird laser sources can have dissimilar beam characteristics asdiscussed above in relation the treatment device of the first embodiment(comprising handpiece 12). Further, in some embodiments, theconfiguration of the treatment device of the second embodiment,including but not limited to the handpiece 112 thereof, will allow forthe efficient and effective combination of the two separate emissions ofthe first laser source and the second laser source for output from theoptical window 122.

Moreover, as in the treatment device of the first embodiment, though notshown in the FIGS. 4-6, the handpiece 112 of the treatment device of thesecond embodiment can further be optionally outfitted with a deliverysystem (e.g., a water supply line and an air supply line) as allows itto facilitate the delivery of water and air to the target tissue areaconcurrently with the delivery of laser energy thereto.

In some embodiments of the invention, the combined emissions from thethree laser sources are understood to have a synergistic effect beyondthat which is understood to be possible from applying just one lasersource. As indicated above, in some embodiments, the first laser sourcecan be a diode laser having a wavelength of about 940 nm, while thesecond laser source can be a solid state Er, Cr:YSGG laser having awavelength of about 2.78 μM. Furthermore, in some embodiments, the thirdlaser source can be a diode laser or LED having a wavelength of about630 nm, about 810 nm, or about 940 nm. Notwithstanding these specificconfiguration values, it will be appreciated by those having ordinaryskill in the art that such particulars can be modified to suit thedesired application. As such, these configuration values are presentedby way of example only and not of limitation.

In some embodiments of the invention, the treatment device can bedesigned and used for wound treatment and healing, in particular,surface debridement, bacteria reduction, and bio-stimulation. In someembodiments, the laser energy emitted from the emission end 10, 110,which is understood to have wavelength, pulse duration, and power levelparameters as described above in relation to the handpieces 12, 112, canbe directed to a target site by the practitioner. In accordance with theinvention, the particular application of the first and second laserbeams applied at a relatively small spot and at a relatively high powerlevel, together with the surrounding relatively large spot of the thirdlaser beam operated at a relatively low power level is understood tosuitable for achieving these objectives. However, other applicableclinical applications include tissue cutting (and related bacteriareduction).

In applicant's co-pending U.S. patent application Ser. No. 14/587,955entitled Dual Wavelength Laser Treatment Device filed Dec. 31, 2013noted above, various synergistic effects of applying multiple lasersources to a target tissue site are described. For example, tissueablation can be enhanced, particularly with respect to ablation rate,precision, and control, with the application of a first laser emissionand a second laser emission. Further, the efficacy of the lasertreatment can be further improved with the inclusion of positive airflowand water spray. Furthermore, synergistic bactericidal effects were alsodisclosed, with the application of the first laser emissionsubstantially weakening certain bacteria and the application of thesecond laser emission killing the weakened bacteria, whereas theseparate application of either laser emission being less effective.

In some embodiments of the invention, other synergistic effects ofutilizing multiple laser energy sources pertaining to bio-stimulationand wound healing can be facilitated by the handpieces 12, 112 describedherein. For example, in some embodiments, the application of higherpower, penetrating laser radiation utilizing diode laser modalities atablative or non-ablative levels can result in the application of lowerlevel laser radiation to surrounding tissue three-dimensionally as aconsequence of the absorption and scattering effects therein. In someembodiments, the concurrent application of YSGG laser pulses also atablative or sub-ablative power levels is understood to generate pressurewaves within the water-rich tissue, and increase the effect of theaforementioned laser light therapy because of the mechanical stimulationof the tissue cells.

In accordance with various embodiments of the invention, the treatmentdevices can include operational parameters for achieving theaforementioned clinical objectives. In particular, for applicationsinvolving a combination of wound debridement, bacteria reduction, andbio-stimulation, the first laser emission can include an output power ofabout 9 W in a continuous (CW) mode. Further; in some embodiments, thesecond laser emission can include an output power of about 10 W that ispulsed at about 15 Hz. In some embodiments, the third laser emission canhave an output power of about 50 to about 1000 mW. In thisconfiguration, airflow and water flow can be used as desired.

In some embodiments, for applications involving a combination ofimproved tissue ablation, coagulation, and bio-stimulation, otheroperational parameters can be used. For example, in some embodiments,the first laser emission can include an output power of about 10 W andcan be operated in a continuous mode. In some embodiments, the secondlaser emission can include an output power of about 10 W, and can bepulsed at about 20 Hz. Airflow and water flow can be used for thistreatment modality. Further, in some embodiments, the third laseremission, like the preceding application requiring a combination ofwound debridement, bacteria reduction, and bio-simulation, can beoperated between about 50 to about 1000 mW in a continuous mode.

In some embodiments, the air flow can be between 0.1 to 5 liters/minute,and the water flow can be between 0.1 to 5 milliliters/minute. In otherembodiments, the water flow and/or the airflow can be outside of theseranges. For example, in some embodiments, the air flow can be less than0.1 liters/minute or greater than 5 liters/minute, and the water flowcan be less than 0.1 milliliters/minute or greater than 5milliliters/minute.

In some embodiments, applications relating to the aforementioned biofilmdisruption and bacterial inactivation can include other operationalparameters. In particular, in some embodiments, the first laser emissionhas an output power of about 1 W, and can be operated in a continuousmode. Further, in some embodiments, the second laser emission caninclude an output power of about 2 W, and can be operated in a pulsedmode. In some embodiments, the pulse frequency of the second laseremission can be about 5 Hz. In some embodiments, the third laseremission likewise can include an output power of between about 50 toabout 1000 mW operated in a continuous mode. In this variation, noairflow and no water flow is required, and may not be used.

In some embodiments of the invention, the aforementioned sequencing ofdriving the multiple laser energy sources can be variously implementedvia signals from a control unit (not shown). The control unit mayinclude a general purpose data processor that executes pre-programmedinstructions stored on an associated memory device that implement suchcontrol methods. Further, in addition to the instructions for drivingthe laser energy sources, the control unit/data processor can furtherinclude instructions for user interface modules that can receiveconfiguration and operating inputs from the practitioner. Only onedriving sequence has been illustrated, but due to the flexibilityafforded in a software-based control system, any suitable Laser energydelivery sequence can be substituted, Other types of sequencing can beused for different therapeutic advantages that can specific forparticular surgical operations. The control unit is understood tomeasure readings from various sensors that trigger appropriate responses(up to and including terminating the laser emissions) upon detectinghazardous operating conditions.

It will be appreciated by those skilled in the art that while theinvention has been described above in connection with particularembodiments and examples, the invention is not necessarily so limited,and that numerous other embodiments, examples, uses, modifications anddepartures from the embodiments, examples and uses are intended to beencompassed by the claims attached hereto. The entire disclosure of eachpatent and publication cited herein is incorporated by reference, as ifeach such patent or publication were individually incorporated byreference herein. Various features and advantages of the invention areset forth in the following claims.

What is claimed is:
 1. A method for laser treatment of a target tissuesite, the method comprising: applying a first laser emission to thetarget tissue site, the first laser emission alone having a firsttreatment effect on the target tissue site; applying a second laseremission to the target tissue site, the second laser emission beingapplied within a predetermined time period of applying the first laseremission during which the target tissue site is subject to the firsttreatment effect from the first laser emission; and applying a thirdlaser emission to the target tissue site concurrently with the firstlaser emission, the third laser emission alone having a third treatmenteffect on the target tissue site; and wherein each of the first laseremission, the second laser emission, and the third laser emission isdefined by a respective set of beam characteristics, one of the beamcharacteristics being a spatial profile, a first spatial profile of thefirst laser emission being substantially the same as a second spatialprofile of the second laser emission, and a third spatial profile of thethird laser emission being larger than the first spatial profile of thefirst laser emission and the second spatial profile of the second laseremission.
 2. The method of claim 1, wherein: at least another one of thebeam characteristics of each of the first laser emission, the secondlaser emission, and the third laser emission are different; and thefirst laser emission, the second laser emission, and the third laseremission have a synergistic treatment effect different from firsttreatment effect, the second treatment effect, and the third treatmenteffect, with the first treatment effect, the second treatment effect,and the third treatment effect being non-linearly enhanced by eachother.
 3. The method of claim 1, wherein the first laser emission, thesecond laser emission, and the third laser emission are combined andemitted from a single output of a treatment device.
 4. The method ofclaim 1, wherein one of the beam characteristics is beam wavelength, afirst beam wavelength of the first laser emission is 940 nm, a secondbeam wavelength of the second laser emission is 2.78 μm, and a thirdbeam wavelength of the third laser emission is selected from a groupconsisting of 630 nm, 810 nm, and 940 nm.
 5. The method of claim 4,wherein: the first laser emission is generated from a diode lasersource; and the second laser emission is generated from a solid statelaser source.
 6. The method of claim 5, wherein the third laser emissionis generated from a diode laser source.
 7. The method of claim 5,wherein the third laser emission is generated from a light emittingdiode (LED) laser source.
 8. The method of claim 4, wherein acombination of the first treatment effect, the second treatment effect,and the third treatment effect includes a combination of wounddebridement, bacteria reduction, and bio-stimulation.
 9. The method ofclaim 8, wherein: the first laser emission has an output power ofapproximately 9 W; the second laser emission has an output power ofapproximately 10 W; the third laser emission has an output power between50 mW to 1000 mW.
 10. The method of claim 9, wherein the second laseremission is pulsed at approximately 15 Hz.
 11. The method of claim 8,further comprising: applying an air flow and a water flow to the tissuesite.
 12. The method of claim 11, wherein: the air flow is between 0.1to 5 liters/minute; and the water flow is between 0.1 to 5.0milliliters/minute.
 13. The method of claim 4, wherein a combination ofthe first treatment effect, the second treatment effect, and the thirdtreatment effect includes a combination of tissue ablation, coagulation,and bio-stimulation.
 14. The method of claim 13, wherein: the firstlaser emission has an output power of approximately 10 W; the secondlaser emission has an output power of approximately 10 W; and the thirdlaser emission has an output power between 50 mW to 1000 mW.
 15. Themethod of claim 14, wherein the second laser emission is pulsed atapproximately 20 Hz.
 16. The method of claim 14, wherein the secondlaser emission is pulsed at approximately 5 Hz.
 17. The method of claim13, further comprising: applying an air flow and a water flow to thetissue site.
 18. The method of claim 17, wherein: the air flow isbetween 0.1 to 5 liters/minute; and the water flow is between 0.1 to 5.0milliliters/minute.
 19. The method of claim 4, wherein a combination ofthe first treatment effect, the second treatment effect, and the thirdtreatment effect includes a combination of biofilm disruption andbacterial inactivation.
 20. The method of claim 19, wherein: the firstlaser emission has an output power of approximately 1 W; the secondlaser emission has an output power of approximately 2 W; and the thirdlaser emission has an output power between 50 mW to 1000 mW.